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Sinus pericranii is a rare vascular anomaly characterized by an abnormal communication between the intra- and extracranial venous systems through a calvarial defect(s). We present three cases of congenital sinus pericranii with facial involvement, emphasizing its cutaneous presentation with diagnostic pitfalls and discuss the multidisciplinary management of this vascular anomaly.

Introduction: Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. Case Presentation: We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. Discussion/Conclusion: For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.

1. Alex Plattner, MD* 2. Sarah Greene, MD, PhD† 3. Elizabeth Nieman, MD‡ 1. *Department of Pediatrics, St Louis Children’s Hospital, Washington University, St Louis, MO 2. †Division of Infectious Diseases, Department of Pediatrics, St Louis Children’s Hospital, Washington University, St Louis, MO 3. ‡Division of Dermatology, Department of Internal Medicine, Washington University, St Louis, MO A 2-month-old, previously healthy girl presented to the emergency department (ED) after being referred by her pediatrician for evaluation of fever and rash. The rash first began at 1 month of age and started as 4 “big and red” spots: 1 each on her face, leg, chest, and back. She was seen in her pediatrician’s office 4 days after the initial symptoms and was prescribed hydrocortisone cream for eczema, with initial improvement. One week later, the patient developed a fever and runny nose, followed by a new rash that was more diffuse across the body and involved the hands and feet (Fig 1). She continued to apply hydrocortisone cream, without improvement, but had ongoing runny nose. At her 2-month health supervision visit she had ongoing runny nose and 2 days of congestion and fever (102°F [38.9°C]). The infant had normal oral intake and urine output, with no change in mental status. The mother denied infant exposure to sick contacts, recent changes in detergents or skin care, and recent travel. Figure 1. Evolving lesions found on the patient’s left lower extremity. The infant was born at 37 weeks and 1 day of gestation via cesarean delivery due to maternal pancreatitis but had a normal newborn course, including a normal newborn screen. Maternal serologic testing during pregnancy was notable for equivocal rubella titer but nonreactive for hepatitis B surface antigen, herpes simplex virus, VDRL/rapid plasma reagin (RPR), and human immunodeficiency virus, all obtained during the …

Infantile haemangiomas (IHs) with functional or cosmetic concerns necessitate systemic treatment for which propranolol is the preferred treatment. However, the mechanism of action is unknown. Mouse models suggest the angiopoietin-2 (Ang2)/Tie-2 system is implicated. Ang2 can promote endothelial growth or induce apoptosis depending on the presence of vascular endothelial growth factor. This pilot study investigates the saliva Ang2 levels in infants with IH treated with and without systemic propranolol. Patients with clinically confirmed IHs were recruited from an academic paediatric dermatology centre. Treatment was based on clinical evaluation. Saliva samples were collected over 6 months. An enzyme-linked immunosorbent assay determined Ang2 levels. Ang2 levels were detectable in 45% of samples. However, by the late time point, only 28% had detectable levels. There were no changes of Ang2 over time, and there were no differences in Ang2 levels between groups. However, Ang2 levels were correlated with baseline size and changes in size from baseline. Ang2 is detectable in saliva of affected infants, but does not decrease with propranolol treatment. However, Ang2 levels are positively correlated with size and changes in size. Thus, Ang2 is not the primary factor in the mechanism of propranolol resulting in IH reduction.

A preterm male infant in the NICU develops a rash with erythematous and hypopigmented macules, patches, and papules of the arms, axillae, neck, upper back, groin, and legs. The rash has a geometric pattern in areas of occlusion (ie, under leads and wires) and maceration with white exudate in the axillae (Fig 1). Figure 1. Erythematous and hypopigmented macules, patches, and papules of the arms, axillae, neck, upper back, groin, and legs. Note the geometric pattern in areas of occlusion (ie, under leads and wires) and maceration with white exudate in the axilla. ### Prenatal and Birth Histories ### Presentation (Day 21) At 21 days of age, the infant was in a double-walled, heated, and humidified isolette and developed the rash described before. At that time, he required nasal continuous positive airway pressure for respiratory support and was tolerating full nasogastric feedings. #### Vital Signs #### Physical Examination

Background aims Delivery of cell-based therapies through the carotid artery with the use of an intra-arterial catheter could introduce aggregates and cause focal ischemia in the brain. We developed a pulse-width flow cytometry method for aggregate detection and quantification. The assay was designed to be used as a cell product release assay in a clinical trial seeking to treat ischemic stroke with sorted cells brightly expressing aldehyde dehydrogenase (ALDH br cells) delivered through intra-arterial catheters. Methods The forward light scatter pulse-width axis of a flow cytometer was calibrated for particle diameter measurements through the use of traceable standard microspheres and linear regression. As a positive control, Concanavalin A–aggregated cells were counted manually and sorted onto slides to compare with pulse width–determined values. Known numbers of aggregates were spiked into purified singlet cells for quantification. A clinical standard for aggregate count and diameter was determined. The assay was used to qualify catheters with the use of ALDH br cells. Results The pulse-width axis was highly linear for microsphere diameter ( r 2 > 0.99), which allowed for size calibration. Microscopically determined counts and diameters corresponded to pulse width-determined values. Known aggregate counts were linear with pulse width–determined aggregate counts ( r 2 = 0.98). The limit of detection was determined to be 0.004%. Flow of ALDH br cells through catheters did not generate aggregates. The final method to be used as a release assay for the stroke clinical trial was tested successfully on samples from volunteer donors. Conclusions The pulse-width aggregate detection assay provides a reliable, reproducible, accurate and rapid means of detection, classification and quantification of aggregates in cell therapy products.

The body of research is rapidly growing regarding the use of telemedicine in patient care, including cost-effectiveness, patient access, patient outcomes, etc. Less has been done describing physician communication during different aspects of the clinical visit (i.e., education, assessment, treatment, etc.) during actual versus virtual patient visits. The purpose of this study was to evaluate dermatology healthcare providers' communication via both modalities with regard to content and style.In-person and teledermatology patient visits were observed, audio-recorded, and transcribed over an 8-month period. A content analysis was performed.The Wilcoxon rank sum test was used to compare the content differences between visit modalities for each category. A p value of 0.05 was considered as significant for all tests. There were no statistically significant differences between modalities in the average number of physician words in seven of eight communication categories: small talk, clinical assessment, psychosocial issues, patient education, patient compliance, patient treatment, and administrative issues (p value range, 0.16-0.91). As well, the same communication themes occurred in each modality to essentially the same degree. For instance, assessment and discussion of treatment occurred in 100% of in-person and teledermatology visits, as did small talk.This research indicates that physician providers communicate with similar style and content whether using teledermatology or in-person.

On June 12, 2007, Chicago Metropolis 2020 and the Federal Reserve Bank of Chicago jointly hosted a conference to discuss road pricing strategies, as well as other issues related to reducing transportation congestion and improving economic efficiency in the Chicago region and around the world. On June 12, 2007, Chicago Metropolis 2020 and the Federal Reserve Bank of Chicago jointly hosted a conference to discuss road pricing strategies, as well as other issues related to reducing transportation congestion and improving economic efficiency in the Chicago region and around the world.